The St. Louis metropolitan area, the seventeenth largest in the U.S. with a population of 2.49 million, is approximately 300 miles distant from the nearest NCI-Designated Cancer Center. Under the leadership of William A. Peck, M.D., Executive Vice Chancellor for Medical Affairs and Dean, Washington University School of Medicine (WUSM), has therefore decided to establish a Cancer Center which will benefit the people of the metropolitan area and the nation. WUSM envisions the Center as the focal point for development of cancer initiatives on campus. The Cancer's major strength will be WUSM's already extensive research portfolio in basic cancer research. Six potential multidisciplinary basic and translational research programs have been proposed by identifying funded scientists who share common interests in conceptual areas that contribute to the pathogenesis of cancer. These include human cancer genetics, cancer and developmental biology, tumor immunology, stem cell biology and gene therapy, cell activation and cell cycle regulation, and cell death. Five potential Center core facilities in protein and nucleic acid chemistry, monoclonal antibodies, fluorescence-activated cell sorting, DNA sequencing, and transgenic mice and embryonic stem cells already exist, and cores in cytogenetics/molecular diagnostics and biostatistics/clinical trials are under development and planned. A strong tradition of interdisciplinary patient management, entry of patients into clinical trials, and specific areas of clinical research excellence form the basis for developing a multidisciplinary clinical cancer research program. Prevention and control research activities are modest, but will benefit from a newly-established program in General Medical Sciences and the establishment of the BJC Health System, consisting of the WUSM, Barnes, Jewish, and St. Louis Children's hospitals on the Medical Center campus, 11 community hospitals, and seven long-term care facilities. Barnes and Jewish hospitals delivered initial treatment to 3,369 adult cancer patients in 1993. Of these patients, 81% were white and 18%, African-American; virtually the same proportion of whites and African-Americans enter NCI-sponsored cooperative group trials. Children's Hospital cares for approximately 110 new oncology patients annually. The institutional commitment to the Center's development is strong and best exemplified by the decision of the Dean to become P.I. of this application. Over the past three years, the Departments of Internal Medicine and Surgery have made major commitments in recruitment, supplemental funding, and space to investigators in clinical and basic oncologic research. The Dean and hospitals have agreed to at least match the $175,000 annually requested for this grant. The Medical School will undertake a major fund-raising drive in 1995 for cancer-related research, clinical activities, and construction. Most cancer outpatient care will be consolidated in a new ambulatory care facility for which ground will be broken within a year, and a free-standing building for the Center is planned after this facility is completed.